The buildup of eosinophils indicates reactions to foods, allergens or acid reflux. This chronic inflammation of EoE or damaged esophageal tissue eventually leads to symptoms.
What are the symptoms of EoE?
The symptoms tend to vary with age.
Infants/Toddlers: dysphagia (difficulty swallowing), food impaction (food getting stuck in the esophagus after swallowing), decreased appetite, abdominal pain, vomiting, failure to thrive
Adults: dysphagia (difficulty swallowing), food impaction (food getting stuck in the esophagus after swallowing), food regurgitation (backflow of undigested food), chest pain, persistent heartburn, epigastric pain
How do you diagnose EoE?
When patients present with dysphagia as the main complaint, an upper endoscopy with biopsies of the esophagus is necessary. An endoscopy will allow the doctor to able to show any esophageal inflammation. When small pieces of esophageal tissues are biopsied, they are sent to a pathologist who can examine under the microscope for the presence and number of eosinophils. The more eosinophils there are, the more severe the condition is.
In some cases, diagnosing EoE consists of an allergist. Patients with EoE tend to have one or more allergic disorders. These disorders could be, but not limited to, food allergy, environmental allergy, asthma or eczema.
What are the options for treatments for EoE?
Lifestyle changes are more effective for symptoms such as heartburn and acid regurgitation. Those include maintaining a healthy weight, avoiding trigger foods and drinks, and elevating the head by using a wedge pillow while sleeping.
Since EoE is a chronic relapsing condition, it requires ongoing treatment to alleviate the symptoms. The treatment involves one or more of the following list:
Elimination Diet: Six main ingredients that should be avoided are diary, wheat, egg, peanut/tree nut, and fish/shellfish. These ingredients commonly cause dysphagia with or without food impaction in patients with EoE. There are options of 6-ingredient elimination diet or 4-ingredient (milk, wheat, soy, egg) elimination diet.
Medication: Proton pump inhibitors (PPIs) are used as a first line of treatment for EoE. While some patients respond well to PPIs with improvement in large decrease in the number of eosinophils and inflammation, some patients need a different option. Another option is a topical steroid that is swallowed to treat EoE. This topical steroid is non-absorbable which means it doesn’t get absorbed into the bloodstream. Therefore, patients are less likely experience common side effects associated with steroids.
Dilation: This can be done during an upper endoscopy. The doctor may recommend dilating or stretching if there is a stricture (narrowing) of the esophagus. The dilation helps swallowing easier as well.
EoE is a disorder that needs to be treated and managed under doctors’ supervision. It is important to re-scope with an endoscopy to check if the condition is getting better or worse. Since the cause or worsening of EoE involves allergens, working with a gastroenterologist and an allergist leads to a greater improvement in patients with EoE.